Does allograft failure impact school attendance in children? A NAPRTCS study

Background. Studies show that adult dialysis patients with allograft failure have increased mortality and morbidity on dialysis compared to transplant naive patients. We previously showed comparable mortality risk in pediatric dialysis patients after allograft failure compared to transplant naive patients; the impact on morbidity is less clear. Specifically, the effect of allograft failure on school attendance in pediatric patients has not previously been studied. Methods. Using the North American Pediatric Renal Trials and Collaborative Studies database, we compared school attendance between transplant naive and allograft failure patients from 1 January 1992 to 31 December 2007. School attendance was compared between the two groups at 6 and 12 months after dialysis initiation using a chi-square test. Factors which can potentially impact on school attendance data were evaluated using a multivariate logistic regression analysis. Results. There were 2783 patients who had a follow-up at least 6 months after dialysis initiation and were capable of attending school during the study period. Patients were categorized by transplant history: previous allograft failure (n = 576) and transplant naive (n = 2207). At 6 months, full-time school attendance was 67.2% in the allograft failure group and 72.3% in the transplant naive group (P = 0.0164). At 12 months, attendance was 68.6% in the allograft failure group and 72.5% in the transplant naive group (P = 0.103). After covariate adjustment, transplant failure did not impact school attendance at either 6 or 12 months follow-up [hazard ratio (HR) 1.12, confidence interval (CI) 0.91-1.39; HR 0.99, CI 0.78-1.27, respectively]. Conclusions. Children with failed allografts who return to dialysis have comparable school attendance compared to their transplant naive dialysis counterparts. These results suggest that transplant failure is not an adverse prognostic factor for quality of life as measured by full-time school attendance.